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Montana rates for HCPCS A9500

Technetium Tc-99m sestamibi, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $151.36 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $134.90 / $776.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $64,565.42 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $281.84 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $114.82 / $177.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $194.98 / $194.98
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $194.98 / $194.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $190.55 / $724.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $114.82 / $234.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68